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Special Feature
July 1999

Pathological Case of the Month

Author Affiliations

From the Department of Pathology/Laboratory Medicine, The Children's Mercy Hospital, Kansas City, Mo.

 

ENIDGILBERT-BARNESSMD

Arch Pediatr Adolesc Med. 1999;153(7):767-768. doi:10.1001/archpedi.153.7.767

A 13-YEAR-OLD Mexican girl was evaluated for a weeklong history of recurrent tonicoclonic seizure activity. The only observation from a medical examination was a small lymph node in the left anterior region of the neck. The girl was alert and afebrile, and findings were normal for complete blood cell count; prothrombin and activated partial thromboplastin times; electrolytes, serum urea nitrogen, creatinine, and glucose levels; and urinalysis. A radiograph of the chest was unremarkable, but a magnetic resonance image of the brain showed a single, small, ring-enhancing lesion surrounded by edema in the subcortical zone of the high left parietal region.

A computed tomography–guided, stereotactic, left frontal craniotomy was performed, and a fairly well-demarcated, hard, ball-like structure was resected. Inspection of the specimen under dissecting microscope demonstrated gray-white brain tissue 1.0 cm in diameter surrounding a smooth, ovoid, yellow-white mass measuring 0.6 cm in diameter. The mass was solid, and cutting the surface revealed 3 variably thick concentric zones: a peripheral zone of translucent pale yellow, a middle zone of translucent pale gray, and a central opaque, sharply demarcated, yellow necrotic zone (Figure 1).

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